Most of us experience our gender identity as consistent with our sex: most people born with female bodies also define their gender identity as female. By the same token, most people who are born with male bodies define their gender as male. Most of us has an internal sense that we are male or female.
For a transsexual person, however, mind and body are at odds: there is conflict between that individual's physical sex and his or her gender identity as male or female. Female-to-male (FTM) transsexuals are born with female bodies, but have a predominantly male gender identity. Male-to-female (MTF) transsexuals are born with male bodies, but have a predominantly female gender identity. In other words, a transsexual male feels he ought to be a female and a transsexual female feels she ought to be a male. If an individual has ever felt he or she is living in the wrong body — that mind and body are at odds — he or she may have a transgendered identity or transgendered leanings.
Used as an umbrella term to describe a broad range of gender identities and experiences, "transgender", unlike "transsexual", is not a medical or psychiatric diagnosis. Rather, it is an all-encompassing term to denote anyone whose gender identity or gender expression falls outside stereotypical gender definitions. And because "transgender" encompasses a broad range of experience, many transsexual people have been willing to take on the label of "transgender".
Similarly, because their gender expression crosses constraining cultural boundaries and definitions, or because they acknowledge that having a same-sex orientation is in itself a challenge, many gay, lesbian, and bisexual people also identify as transgender.
"Transgender" includes but is not limited to:
Pre-operative, post-operative, and non-operative transsexual people;
Male and female cross-dressers (sometimes called transvestites, drag queens, or drag kings);
Intersexed individuals; and Men and women, who, regardless of their sexual orientation, are seen as gender
It's important to distinguish transgenderism from transvestism. A transvestite (also called a cross-dresser) is someone who feels a strong need to dress in clothes typically worn by the opposite gender but who does not wish to become that gender. Transvestites can be people who see themselves as both masculine and feminine. Similarly, they can also be people who challenge traditional gender roles — people who don't wish to be limited by what society says is "appropriate" or "inappropriate" for men and women. Most societies have rules that govern gender roles and that dictate how men and women should behave. These rules, however, vary from culture to culture.
It's also equally important to note that being transgendered is not the same as having a same-sex orientation. While it is true that some transgendered people may feel attracted — sexually, affectionally, romantically — to members of their own biological gender, others don't. Even those with a same-sex orientation have a tendency to view themselves as heterosexual members of the opposite gender rather than as homosexuals. In other words, transgenderism is about how an individual experiences him or herself — not about what turns him or her on.
Although one's dissatisfaction with his or her biological gender is shared by many people throughout the world, it's unclear just why some people are transsexual or transgendered. Some transsexual or transgender people knew from early childhood that they were different from other children while others became aware of these feelings during adolescence or young adulthood.
The first realization they are somehow different from their peers often causes feelings of shock, fear, shame, and confusion. They may suffer emotional pain from feeling "trapped in the wrong body". As such, they may hide their transgender leanings from those around them and from themselves, not fully understanding their feelings until they reach adulthood. Coming to terms with transgender feelings is not only difficult, it also requires courage and honesty.
Some transgendered or transsexual people may find their transgendered leanings dissipate as they get older. For others, however, the urge to live as the opposite gender becomes increasingly stronger with age. Those who reach adulthood without ever acting on these transgender leanings may wonder whether they may be happier as the opposite gender. Luckily, transgender support groups exist in many parts of the world. In addition to providing emotional support, such groups can help transsexual or transgendered people weigh the options and explore the various choices available.
While some transsexual or transgendered people may continue to live all or most of their lives feeling "trapped", others may decide it's important for others to see them as they see themselves. They may take steps to help others understand who they are and/or to feel more comfortable with themselves. This process of self-disclosure — or "coming out" — often leads transsexual or transgendered people in new and rewarding directions. Although some may experience rejection (see Being invisible), many find a high level of support among family and friends. Coming out also allows transsexual and transgendered people to:
Overcome the shame often associated with hiding a part of themselves from others;
Have greater control over their lives;
Feel more connected with their bodies;
Teach others about their lives;
Have more open and honest relationships;
Develop increased self-esteem and self-confidence; and
Serve as role models for others.
For some transgendered or transsexual people, the process of "coming out" may mean living "in role" as a person of the opposite gender only some of the time and living "in drab" (as a member of their biological gender) the rest of the time. Others may choose only to go as far as living "in role" and undergoing hormonal treatment (see end note). Still others may live "in role" at all times, with a view to possibly undergoing gender reassignmen surgery (also called a sex change operation).
It's not uncommon for those wanting gender reassignment surgery to be asked to live "in role" for a year or longer before a health provider will consider a sex change operation. This period is called "transition" and may involve:
Changing one's name and records;
Changing one's hair and clothing style and living "in role";
Undergoing hormonal treatment to help one's body change; and/or
Undergoing surgeries to physically change one's body.
Transition may seem long and can be costly. Some transsexual or transgendered people may live out the rest of their lives in transition. Those still intent on gender reassignment surgery often use this time to carefully think about and explore other options. Gender reassignment is a life-altering, irreversible step.
A word about hormones...
Some transgender and transsexual people, although they are suitable candidates for and can afford gender reassignment surgery, choose not to have it. Instead, they choose to take hormones and to live in transition indefinitely. This practice is not condoned by the medical community, and some living in transition have been abandoned by their doctors and support groups/community for doing so.
Often referred to as autogynophilia (a sexual fixation with modifying one's body), this practice does not fall within the Harry Benjamin test, a guidework set out and followed by the few medical doctors who will treat transgendered people. Psychologists and general practitioners who treat transfolk also follow those standards.
Some health providers, however, are not aware of these guidelines. For instance, it's not uncommon for endocrinologists not to know how to care for a person in transition. In some cases of male-to-female (MTF) transsexuals, some doctors have prescribed the same dosages of hormones as they would to women undergoing hormone replacement therapy. In a transsexual, these dosages are patently ineffective.